Optic disk edema and macular serous retinal detachment as an early sign of Bartonella

henselae systemic infection

Dr. Carlos Alvarez-Guzmán 1

Dr. Alejandro Rodríguez-García 2

1 Ophthtalmology resident. Escuela de Biotecnología y Salud, Tecnológico de Monterrey – Mexico

2 Chief director of Ocular Immunology and Uveitis Clinics; Academic Director of Ophthalmology Residency. Escuela de Biotecnología y Salud, Tecnológico de Monterrey-Mexico

Patient history and clinical exam

• 38 y/o male with a 4-day history of flu-like illness and blurred vision in his LE .

• Medical history– Hyperlipidemia.

• Medications: none• Social history

– Parrots, tucans and macaws as pets.

• VA: OD 20/15; OS 20/30• Amsler: cecocentral scotoma OS• Rx: OD PL, OS +0.50• S/C: White and quiet• AC: D&Q• Pupils: 3mm, LR +2, No RAPD• IOP: 14 mmHg OU• Fundus exam OS: optic disc edema,

mild hyperemia and flame shaped hemorrhage associated with peripapillary serous retinal detachment of 3 DD. Clear vitreous.

Late leakage of optic nerve

OD within normal limits

Late leakage of optic nerveLate leakage of optic nerveLate leakage of optic nerve

Optic disc edema with loss of foveal reflex: macular RD

Optic disk edema and hemorrage

• 3 weeks later a macular star developed and optic disc started to resolve

• VA improved to 20/40• Prednisolone was started

40mg/day PO for 3 weeks

• 11 weeks later optic disk edema resolved

• Macular exudates diminished• VA improved to 20/25• Prednisolone was tapered.

Diagnostic tests

• CBC with differential, RPR, FTA ABS, PPD and CXR within normal limits.

• Serum anti-Bartonella henselae– IgG 1:2560, IgM 1:800

• Started on:– Doxycycline 100mg PO bid– Rifampicin 300mg PO bid

• One week later VA decreased to 20/200 and optic disc edema persisted.

Discussion• Neuroretinitis is a unique form of optic neuropathy associated with a

complete or partial macular star.

• Optic disk edema associated with peripapillary serous retinal detachment appears to be a common yet unrecognized sign of systemic B. henselae infection.

• Many patients will develop a macular star within weeks of the onset of visual symptoms.

• Early signs that help to distinguish B.henselae associated papillitis from other forms of anterior optic neuropathy are important for both diagnosis and therapy.

References1. Kevin Wade MDCM, et al. Optic disk edema associated with peripapillary serous retinal detachment: an early sign of systemic Bartonella henselae infection. Am J Ophtalmol 2000;130:327-334.

2. Solley W., et al. Cat scratch disease. Posterior Segment Manifestations. Ophthalmology 1998;106:1546-1553.

3. Reed et al. Bartonella henselae neuroretinitis in cat scratch disease. Ophthalmology 1998;105:456.466.

4. Zacchei AC, et al. Serous retinal detachment of the macula associated with cat scratch disease. Am J Ophtalmol 1995;120:796-797.

5. Suhler EB, et al. Prevalence of serologic evidence of cat-scratch disease in patients with neuroretinitis. Opthalmology 2000;107:871-876.